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Acute Asthma - How to Recognise and Treat





by Dr. Sarah Myhill


Updated January 2008



Nothing beats experience! Once an acute attack of asthma has been seen or experienced it is immediately recognised when it occurs again. The symptoms may begin with cough and proceed to shortness of breath and wheeze. All asthmatics should have a peak flow meter to allow them to gauge the severity of an attack and check on response to treatment. Peak flow varies through the day with early morning dips: this is when asthma attacks are worst.


Some people have "brittle" asthma which means they have the potential to deteriorate rapidly. They should always have steroids in the house and not be afraid to take them early because they take up to 6 hours to work properly. These people should seek professional help early.


Acute asthma attacks kill people and should always be taken seriously. Now is not the time to muck about with alternative remedies, something has to be done!


Mild Asthma Attacks


Slight drop in peak flow
Asthmatics often hyperventilate during an acute attack, so do hyperventilation exercises including rebreathing into a paper bag. Calmness is the order of the day. Try to find out and remove the cause of the attack, it may be physical (such as exercise, cold air) emotional (nothing like a good argument!), allergic, infection (a cold) etc. A strong cup of black coffee (caffeine) may help as caffeine is a good bronchodilator. Use the peak flow meter to check for improvement.


Moderate Asthma Attacks


A drop in peak flow to 300 litres/min
Do the above, plus use the blue inhaler (bronchodilator). The peak flow should improve after the inhaler has been used. If not, use a nebuliser. Try a combination of things, first a beta agonist (such as salbutamol) or an anticholinergic (ipratropium), I would put in magnesium sulphate which is a good bronchodilator. Some asthmatics have their own nebuliser. If not, it is a trip to casualty!


Severe Asthma Attacks


A drop in peak flow to 150 litres/min and/or brittle asthmatics.
Send for medical help, or go to casualty. In the meantime whilst waiting for help do:

  • All the above.
  • Take steroids by mouth: prednisolone takes 4-6 hours to work.
  • Use oxygen if you have got it.
  • Think: could there be another cause?? A spontaneous pneumothorax (collapsed lung) may cause sudden severe shortness of breath in someone otherwise completely healthy. In children especially think of foreign bodies: has a peanut been inhaled?
  • Acute heart failure, pulmonary embolus can cause a similar acute shortness of breath and all need professional help quickly.





AFTER THE ATTACK - try to work out what caused the attack. See - Asthma - How to Find Out the Cause

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